Clinical significance and management of subsegmental pulmonary embolism

Ikesaka, Rick; Carrier, Marc

doi:10.1007/s11239-015-1169-7

Cited by 41 publications

(33 citation statements)

References 42 publications

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“…Metha et al . and Ikesaka et al . have suggested that withholding anticoagulation in patients with single subsegmental PE and serial negative lower leg compression ultrasound appears to be safe.…”

Section: Discussionmentioning

confidence: 99%

Suspected pulmonary embolism in patients with pulmonary fibrosis: Discordance between ventilation/perfusion SPECT and CT pulmonary angiography

Leuschner

Wenter²,

Milger

et al. 2016

Respirology

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Background and Objective: Pulmonary embolism (PE) is a common differential diagnosis in patients with pulmonary fibrosis presenting with a clinical deterioration. Both ventilation/perfusion (V/Q)-single photon emission computed tomography (SPECT) and computed tomographic pulmonary angiography (CTPA) are routinely used to detect PE. However, the value of V/Q-SPECT and CTPA in this scenario has not been studied so far. We aimed to investigate the concordance of V/Q-SPECT and CTPA in patients with pulmonary fibrosis and suspicion of pulmonary embolism. Methods: A total of 22 consecutive patients with pulmonary fibrosis and clinical deterioration who underwent both V/Q-SPECT and CTPA were included in the study and analyzed for the presence of pulmonary embolism. Results: Nine of 22 patients (41%) had evidence for pulmonary embolism in V/Q-SPECT, and two of these patients had matching evidence for pulmonary embolism in CTPA. In the other seven patients with positive findings in V/Q-SPECT, no evidence of pulmonary embolism was found in CTPA. None of the 13 patients with a negative V/Q-SPECT had evidence for pulmonary embolism in CTPA. Conclusion: In patients with pulmonary fibrosis and suspected pulmonary embolism, pulmonary embolism is detected more frequently by V/Q-SPECT than by CTPA. Thromboembolic disease is identified on CTPA only in a minority of patients with positive findings on V/Q-SPECT. When making treatment decisions, clinicians should be aware of the high rate of discordant findings in V/Q-SPECT and CTPA in this specific patient population.

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Section: Discussionmentioning

confidence: 99%

Suspected pulmonary embolism in patients with pulmonary fibrosis: Discordance between ventilation/perfusion SPECT and CT pulmonary angiography

Leuschner

Wenter²,

Milger

et al. 2016

Respirology

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“…In many older adults, there is a net clinical benefit with appropriate OAC prescription. Reflective of these and other emerging data, many guidelines, recommendations, and clinical practice patterns are shifting away from identifying high‐risk individuals who should be treated and toward identification of truly low‐risk individuals in whom OAC may safely be deferred . The identification and elimination of modifiable bleeding risk factors in older adults is also paramount (Table ).…”

Section: Treatment Of Vte In Older Adultsmentioning

confidence: 99%

Pathogenesis, Diagnosis, and Treatment of Venous Thromboembolism in Older Adults

Johnson

Eleazer

Rondina

2016

J American Geriatrics Society

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Older adults have a significantly greater risk of venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, than younger adults. The cause of this greater risk is thought to be multifactorial, including age-related changes in hemostatic factors and greater comorbid conditions and hospitalizations, but is not completely understood. Moreover, VTE remains underrecognized in older adults and may present atypically. Thus, a low index of clinical suspicion is essential when evaluating older adults with possible VTE. Despite this underrecognition in older adults, the diagnostic approach remains similar for all age groups and includes estimation of pretest probability, measurement of the D-dimer, and imaging. Antithrombotic agents are the mainstay of VTE treatment and, when used appropriately, substantially reduce VTE recurrence and complications. The approval of novel oral anticoagulants (NOACs), including dabigatran, rivaroxaban, apixaban, and edoxaban, provide clinicians with new therapeutic options. In some individuals, NOACs may offer advantages over warfarin, including fewer drug interactions, more-predictable anticoagulation, and lower risk of bleeding. Nevertheless, anticoagulation of VTE in older adults should always be performed cautiously, because age is a risk factor for bleeding complications. Identifying modifiable bleeding risk factors and balancing the risks of VTE recurrence with hemorrhage are important considerations when using anticoagulants in older adults.

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“…21 Patients with cancer having subsegmental PE are frequently treated with anticoagulation due to the underlying heightened risk of recurrent VTE. 19,22 The optimal duration of anticoagulation is not clear in patients with subsegmental PE. Based on the ACCP guidelines, the duration of anticoagulation depends on the presence of transient risk factors, presence of cancer, number of VTE, and risk of bleeding.…”

Section: Management Of Other Vtementioning

confidence: 99%

An Algorithmic Approach to Management of Venous Thromboembolism

Dhakal

Gundabolu

Bhatt

2016

Clin Appl Thromb Hemost

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Venous thromboembolism (VTE) is associated with significant morbidity and mortality. Factors such as the presence of transient risk factors for VTE, risk of bleeding, and location of deep vein thrombosis (DVT) determine the duration of anticoagulation. Extended anticoagulation is offered to patients with unprovoked pulmonary embolism (PE) or proximal DVT and a low risk of bleeding. Anticoagulation for 3 months is advised in patients with provoked DVT or PE, high risk of bleeding, and isolated distal or upper extremity DVT. In patients with unprovoked PE or proximal DVT and a low risk of bleeding, who want to stop anticoagulation after 3 months, further risk stratification is necessary. Clinical scoring system, and thrombophilia testing otherwise not routinely performed, may be considered to measure risk of annual recurrence in such cases. Short-term anticoagulation may be considered in subsegmental PE and superficial vein thrombosis, particularly if patients are at low risk of bleeding and have persistent risk factors for recurrent VTE. In cases of catheter-associated thrombosis, the catheter need not be removed routinely, and the patient may be anticoagulated for 3 months or longer if the catheter is maintained in patients with cancer. Extensive screening for occult cancer in cases of unprovoked VTE is not beneficial. New oral anticoagulants such as apixaban, rivaroxaban, or dabigatran may be preferred to vitamin K antagonists in patients without cancer or renal failure, more so after the development of reversal agents such as idarucizumab and andexanet alfa.

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Clinical significance and management of subsegmental pulmonary embolism

Cited by 41 publications

References 42 publications

Suspected pulmonary embolism in patients with pulmonary fibrosis: Discordance between ventilation/perfusion SPECT and CT pulmonary angiography

Suspected pulmonary embolism in patients with pulmonary fibrosis: Discordance between ventilation/perfusion SPECT and CT pulmonary angiography

Pathogenesis, Diagnosis, and Treatment of Venous Thromboembolism in Older Adults

An Algorithmic Approach to Management of Venous Thromboembolism

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